When the fever will not stop, stop the pills! A case report

ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.

When the fever will not stop, stop the pills! A case report.

BACKGROUND: Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.

Protocolo y algoritmo de diagnóstico, tratamiento y derivación ágil de las úlceras de la extremidad inferior / Protocol and algorithm for diagnosis, treatment and early referral of lower limb ulcers

Las úlceras venosas son una patología muy prevalente, especialmente en pacientes de edad avanzada. repercutennegativamente en la calidad de vida de los pacientes y conllevan un importante consumo de recursos. este artículopropone un práctico algoritmo para el diagnóstico y el tratamiento de las úlceras en la pierna con el objetivo deoptimizar su manejo. existe una amplia literatura sobre el tema, pero sigue existiendo una brecha entre la evidenciacientífi ca y la práctica clínica que seguimos tratando de minimizar. Laboratorios Urgo propuso al Capítulo español de Flebología y Linfología la creación de un comité de expertos deespaña y portugal para la elaboración de un algoritmo de diagnóstico, tratamiento y derivación ágil de las úlcerasen la extremidad inferior. Se realizó una búsqueda bibliográfica sistemática y se tuvieron en cuenta las guías depráctica clínica (GpC). Se diseñó un algoritmo sobre una regla nemotécnica alfabética que busca ayudar a memorizar los pasos clave deldiagnóstico y del tratamiento de estas úlceras. Se englobaron todos los aspectos prácticos, desde la valoración en atención primaria por médicos y enfermerashasta la atención especializada por el especialista en angiología y cirugía vascular. Con las letras del abecedario dela a hasta la F, resumimos los pasos necesarios para asegurar el diagnóstico de la úlcera, el mejor (best) tratamientolocal, terapia compresiva, tratamiento preventivo de recidiva después de la cicatrización de la úlcera y estrategiaquirúrgica y farmacológica.el diagnóstico preciso, la actuación correcta ajustada a las GpC y la derivación temprana para valorar estrategiasquirúrgicas o escleroterapia contribuyen a la resolución y a la reducción del tiempo de cicatrización de las úlcerasy la mejora de la calidad de vida de los pacientes. Seguir las GpC a través de un algoritmo reduce el consumo derecursos y de gasto, acelerando la cicatrización de la úlcera y previniendo su recidiva.(AU)

Venous ulcers are a prevalent disease, especially in elderly patients. they have a negative impact in patients’ qualityof life and carry a significant economic burden. this article suggests an algorithm for the diagnosis and treatment oflower extremity ulcers in order to optimize their management. there is huge evidence and multiple organizationshave published guidelines, consensus documents and treatment recommendations. nevertheless, there is still agap between evidence and clinical practice. Urgo Laboratories proposed the Spanish phlebology and Lymphology Chapter the creation of a Spanish andportuguese experts committee the elaboration of an algorithm for diagnosis and treatment and early referral oflower extremity ulcers. a systematic review was performed, considering the current clinical practice guidelines. the algorithm was designed on a simple alphabetic mnemonic rule aiming to easily memorize the key points andmost relevant issues of the diagnosis and treatment of these ulcers.all necessary steps from primary care nurses and physicians to Vascular Surgery were considered. With the alphabetletters from a to F in Spanish, all key points were summed up. to confirm ulcer diagnosis (asegurar el diagnóstico dela úlcera), best local treatment, compressive therapy, preventive treatment after healing (tratamiento preventivo derecidiva después de la cicatrización de la úlcera), surgical strategy (estrategia quirúrgica) and pharmacological strategy(estrategia farmacológica).an accurate diagnosis, a clinical practice according to the clinical practice guidelines and an early referral to thespecialist in order to determine if there is a surgical or interventional strategy are essential to effective resolutionand reduction of ulcer healing time, and finally to prevent its recurrence.(AU)

The impact of demographic and clinical characteristics on diabetic painful neuropathy.

INTRODUCTION: Diabetic neuropathy (DN) is one of the most devastating complications of diabetes mellitus; however, in contrast to other countries, there are no scientific studies in Portugal evaluating the impact of demographic and clinical characteristics of this pathological entity. The aim of this study was to evaluate the impact of gender, metabolic control, age of diabetic patients, as well as time of disease progression, the appearance of complaints related to neuropathic pain. MATERIAL AND METHODS: A multicentre study with a non-probabilistic, convenience sample of 359 patients was performed employing the quantitative method, using the Statistical Package for Social Science 24 software. The p-value of p < 0.05 was defined to consider a result statistically significant. The Spearman correlation coefficient (r) was determined to determine the relationship between categorical variables. RESULTS: There was no statistically significant difference in the prevalence of DN between genders (p = 0.633 and r = 0.025). There was a statistically significant relationship between the value of HbA1c and DN, with p = 0.010 and r = 0.136. There is a relationship between age and complaints of neuropathic pain, with p = 0.034 and r = 0.112. The variable, time of disease progression, is also correlated with the appearance of complaints of neuropathic pain with p = 0.020 and r = 0.112. CONCLUSION: The prevalence of neuropathic pain in subjects with diabetes is not negligible and is associated with modifiable risk factors that can be identified, possibly modified and prevented. The correct approach for these patients, which involves screening and early treatment, is decisive improving functionality and quality of life.

[Fungal endocarditis with central and peripheral embolization: case report]. / Endocardite fúngica corn embolização central e periférica: um caso clínico.

A 50-year-old man with a history of drug addiction was admitted to the cardiology department for aortic valve fungal endocarditis complicated by severe aortic regurgitation, cerebral infarcts and right common iliac artery pseudoaneurysm. While awaiting transfer to the cardiothoracic surgery department, the patient presented acute arterial ischemia of the left leg, and distal left patellofemoral embolectomy was successfully performed. The patient was then transferred to the cardiothoracic center and the aortic valve was replaced by a bioprosthetic valve. After fourteen days he was referred for vascular surgery, where the four-month hospitalization was complicated by left leg amputation. Four months after discharge, the patient was admitted to the emergency department for recurrent fungal endocarditis complicated by multiple renal and splenic infarcts and celiac trunk embolization. He was transferred to the cardiothoracic surgery department, but suffered cardiac arrest before surgical intervention.

Evolução do estado nutricional de crianças submetidas à palatoplastia posterior, alimentadas através de mamadeira ou colher / Evolution of nutritional status of children undergoing palatoplasty later, fed by bottle or spoon / Evolución del estado nutricional de los niños sometidos a palatoplastia más tarde, alimentados con biberón o la cuchara

Objetivo: Avaliar se o instrumento utilizado para o oferecimento da alimentação influenciou o estado nutricional dos pacientes.Métodos: Dezenove crianças (G1) e 8, com colher (G2), foram submetidas à avaliações dietética, antropométrica e laboratorial no dia anterior à cirurgia (M1) e 30 dias após a alta (M2). os dados foram analisados por média, desvio padrão, teste "t" pareado e teste "t" de Student. Resutados: Os seguintes resultados foram observados: 1. nenhuma variação significante na ingestão alimentar; 2. ganho ponderal entre os momentos do estudo para G1 bem como incremento no Peso pela Idade (Pe/I) e no Comprimento pela Idade (C/I); 3. redução significante nos valores de hemoglobina e hematócrito em M2 para G2. Conclusão: Os diferentes instrumentos mostraram a mesma influêmcia nos indicadores dietéticos e laboratorias, entretanto, os antropométricos demonstraram maiores incrementos em seu crescimento.

Objective: To evaluate whether the instrument used for the offering of food influenced the nutritional status of pacientes.Métodos: Nineteen children (G1) and 8 with spoon (G2) underwent dietary assessment, anthropometric and laboratory on the day prior to surgery ( M1) and 30 days after discharge (M2). the data were analyzed by mean, standard deviation, t-test and paired t test of Student. Overall result: The following results were observed: 1. no significant variation in food intake, 2. between weight gain during the study for G1 and increase in weight for age (Fr / I) by Age and Length (C / I), 3. significant reduction in hemoglobin and hematocrit in M2 for G2. Conclusion: The different instruments showed the same influêmcia laboratorias and dietary indicators, however, demonstrated greater increases in anthropometric growth.

Objetivo: Evaluar si el instrumento utilizado para la oferta de alimentos influido en la situación nutricional de pacientes.Métodos: Diecinueve niños (G1) y 8 con una cuchara (G2) se sometieron a la evaluación dietética, antropométrica y de laboratorio en el día antes de la cirugía ( M1) y 30 días después del alta (M2). los datos fueron analizados mediante media, desviación estándar, t-test y vinculado prueba de la t de Student. Total de resultados: Los resultados fueron los siguientes: 1. ninguna variación significativa en la ingesta de alimentos, 2. entre el aumento de peso durante el estudio para el G1 y el aumento de peso para la edad (Fr / I), por edad y longitud (C / I), 3. reducción significativa de la hemoglobina y el hematocrito en M2 en el G2. Conclusión: Los instrumentos diversos mostró la laboratorias influêmcia misma y los indicadores de la dieta, sin embargo, demostraron un mayor aumento en el crecimiento antropométrico.

Immediate postoperative evaluation of the surgical wound and nutritional evolution after cheiloplasty.

OBJECTIVE: To evaluate the nutritional status and behavior of the surgical wound following cheiloplasty. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, São Paulo, Brazil. PARTICIPANTS: Forty-five nursing children aged 3 to 13 months old, either bottle-fed or spoon-fed, submitted to cheiloplasty during the study period. RESULTS: The results did not demonstrate significant differences between the study groups regarding gender, age, nutritional status, and condition of the surgical wound. Upon completion of the study, the infants of both groups were eutrophic, presenting increase in growth and development, with no hematoma, significant edema, sutural dehiscence, bleeding, or infection at the operated area. CONCLUSIONS: Both kinds of nursing, spoon- and bottle-feeding, had the same influence on nutritional status and wound condition in both study groups. We suggest that bottle-feeding should be tried in patients in the postoperative period of cheiloplasty, because this method was used after surgery without causing any damage to the lip surgical wound.